Convincing some elders to see their doctors for any reason can be difficult. Convincing them to give honest answers to the doctor’s questions can be even more challenging. This is especially true when the elder gets into uncomfortable territory. Areas where they feel they will be judged.
The issues that are probably most often covered up are alcohol or drug abuse, but not far behind would be cognitive problems. It’s been known for some time that dementia has overtaken cancer as the most feared disease. It’s also well known that there’s no cure for dementia at this time. Additionally, even people with healthy brains who make an occasional wrong decision have a tendency to cover up. It’s human to dislike our thought process questioned since our brain represents so much of our identity. So, rather like children who cover their eyes and say "you can’t see me," people often feel that if they aren’t diagnosed with dementia, well, dementia isn’t their problem.
Getting to the physician
The most successful way to convince an elder to see a physician is often to suggest a general physical so that they can get their blood pressure prescription, or whatever other drugs they need, renewed. The physical will probably go okay, but when the doctor wants to chat about general health concerns, things can get dicey.
The doctor asks if they are taking their medications as directed. The answer, of course, is "yes." Do they drink much alcohol? The answer is "only an occasional beer or glass of wine after supper." Have they noticed that they are running into problems balancing the checkbook or forgetting appointments? "No, no problems there." Adult children or spouses accompanying their loved ones to these appointments often feel powerless, or at least uncomfortable, if they try to contradict the elder’s fuzzy answers.
Getting around your loved one’s cover-up
While cognitive abilities are affected by the various types of the disease, dementia does not lower IQ. People with dementia can often put up a very effective front in order to convince the doctor that nothing is wrong.
I’d suggest that you try to schedule your loved one’s appointment with a geriatrician, if possible. These specialists on aging are less likely than many time-pressed general physicians to be misled by evasion when looking for cognitive issues in elders. If you can’t land an appointment with a geriatrician - or even if you can - one way to inform the physician that there are issues that make you question your parent’s cognitive health is to write the doctor a letter before the appointment. A telephone call is good, but you’re unlikely to get past a nurse. A good nurse, taking good notes, may be enough. A letter listing explicit incidences that are concerning you may be even better, though. Include the frequency of occurrences of the events and even dates if you’ve kept track. This approach will arm the physician with the necessary information so that he or she can ask the right questions and even order the correct tests.
Often, the testing will start gently with a quick in-office exam such as the Mini Mental State Exam (MMSE) or any one of several others that can help evaluate cognitive function such as memory, orientation, reasoning and judgment, language skills, and attention.
Office cognitive checkups are evolving, so the physician may try another approach instead. Eventually, if needed, the doctor may order further tests or refer your loved one to a neurologist who specializes in dementia. This, too, may result in a fight for you, but if the first physician handled the office visit well, maybe some of your elder’s defenses will be broken down. Much depends on conveying to the elder that having some cognitive issues does not mean life is hopeless, and should they show signs of dementia there are some medications that can slow the mental decline if started early enough. You won’t win every battle while caring for your loved one, but getting this one checkup is a good start.
Locke, T. (2011, February 8) Dementia overtakes cancer as biggest health fear. WebMD Health News. Retrieved from http://www.webmd.boots.com/alzheimers/news/20110208/dementia-overtakes-cancer-as-biggest-health-fear
Mayo Clinic staff. Tests and diagnosis. Retrieved from http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=tests-and-diagnosis
National Institutes of Health. Detecting Dementia with the Mini-Mental State Examination (MMSE) in Highly Educated Individuals. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587038/
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.